Alcohol and Sex Addiction: Can One Cause the Other?

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Alcohol misuse is a widespread public health problem in the United States. According to the 2019 National Survey on Drug Use and Health, 25.8% of people over 18 had engaged in binge drinking in the last month.¹ Alcohol misuse can lead to high-risk behaviors, including those involving sex.²

Clinical Criteria for Alcohol and Sex Addiction

Mental health professionals use the Diagnostical and Statistical Manual of Mental Disorders (DSM-5) to diagnose and evaluate mental health conditions like addiction.

Alcohol Misuse and Addiction

Alcohol addiction, or “alcoholism,” is diagnosed under the name alcohol use disorder (AUD). AUD is a set of behaviors and symptoms that can be mild, moderate, or severe. AUD is characterized by “a problematic pattern of alcohol use leading to clinically significant impairment or distress.” ²

Behaviors that may fit this criteria include sexual behaviors such as having unprotected sex with multiple partners, which is associated with an increased risk of contracting a sexually transmitted infection (STI).^2,3

A person can misuse or be dependent on alcohol without being addicted to it; however, patterns of alcohol use as well as the development of dependence, tolerance, and withdrawal are part of diagnosis alcohol use disorder. Because alcohol lowers inhibitions and impairs decision-making, high-risk behaviors are associated with binge drinking, heavy alcohol use, and alcohol dependence.⁴

Sex Addiction

Addiction is primarily associated with substances that can be put into the body, but behavioral addictions (aka process addictions) can be equally destructive and debilitating.⁵

The DSM-5 recognizes some process addictions, like compulsive gambling. However, “sex addiction” is not an official clinical mental health diagnosis.

Sex addiction is not considered diagnosable because there is not enough authoritative research to establish universal criteria that a mental health professional could use to diagnosis it as a mental health condition.^2,3 Alcohol use disorder, for example, has 11 criteria. A person with 2 or more criteria in the past year has mild AUD, a person with 3-5 or more criteria has moderate AUD, and a person with 6 or more criteria has severe AUD.

Sex addiction does not have behaviors and symptoms that have been observed to be universal in this way. Research has also not shown it to be a medical condition, unlike substance use disorders, where observable chemical alterations happen in the brain.

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What Is Sex Addiction?

Compulsive sexual behavior (CSB) is defined as difficulty controlling inappropriate sexual urges, fantasies, or behaviors to the point that it causes distress and impairment.³

To the degree that it has been defined by the mental health community, sex addiction, sometimes referred to as nymphomania or hypersexuality, is defined as a recurring obsession with and urge to engage in sexual acts.⁵

CSB can refer to different facets of sex addiction including:^3,5

• Obsessive viewing of adult material
• Excessive casual sex
• Excessive masturbation
• Paid sex that is dangerous, illegal, or excessive
• Exhibitionism that leads to immoral or illegal sexual behavior
• Voyeurism that leads to immoral or illegal sexual behavior
• Socially taboo or obsessive paraphilias (fetishes)

Obsessive vs. Excessive vs. Stigmatized

In this context, “obsessive” refers to when a person begins to think about the behavior and feel urges to engage in the behavior to the degree that it affects their ability to focus, complete tasks, etc.

“Excessive” refers to when the behavior interferes with relationships (e.g., casual sex endangers an existing romantic relationship) or with daily living activities (e.g., is so excessive that it affects personal obligations).

Stigmatized thoughts, behaviors, and professions are sometimes assumed to be part of compulsive sexual behavior or sex addiction. However, social stigma does not necessarily make these thoughts or actions part of an addiction. For example: ²

• Casual sex must be viewed through the context of a person’s circumstances. A single person who engages in protected sex casually and routinely seeks STD screenings is highly unlikely to have a sex addiction, but a person who hides a pattern of excessive casual sex that they use to numb emotional pain may have one.
• Paid sex that is legal is not inherently part of a compulsive behavior pattern. For example, viewing adult cam model shows is not compulsive, but if a person were to go into extensive debt to pay for private sessions with a specific cam model, this could be both obsessive and excessive even though it is legal.
• Paraphilias, including exhibitionism and voyeurism, are not mental health disorders unless they cause distress to the individual or harm to others. Paraphilias—also casually called “fetishes” or “kinks”—that can be engaged in legally, by consenting adults, and without distress are not part of any mental illness, addiction, or process disorder.

Who Is Most Likely to Have Sex Addiction?

Due to the lack of research and disclosure, it is difficult to know just how prevalent sex addiction actually is. Preliminary research estimates that about 3% of men and 1% of women struggle with compulsive sexual behavior.³

Teens and Young Adults

Studies have found that teens are especially vulnerable to risky sexual behaviors when under the influence of alcohol or other substances. Research has revealed an association between teen substance use and engaging in sexual intercourse, not using a condom, having multiple partners, and unintentional pregnancies before 15 years of age^.8

The research also found that, as substance use increases, the likelihood of sexual intercourse and sex with multiple partners also increases. Teenagers in the study who reported no substance use were the least likely to engage in risky sexual behaviors.⁸

Alcohol use is also associated with risky sexual behavior in young adults. Several studies have shown an association between alcohol consumption and less consistent condom use, casual sex, and multiple sexual partners. Alcohol consumption is associated with increased rates of sexually transmitted infections (STIs) and unintended pregnancies.⁶

Alcohol consumption has also been linked to sexual assault. Women are more likely to be sexually assaulted while under the influence of alcohol, and men are more likely to perpetrate sexual violence while intoxicated.⁶

Signs and Symptoms of Sex Addiction

Behavioral addictions like sex addiction can be difficult to identify, as many people have hobbies and behaviors that take up a significant portion of their free time. What distinguishes a hobby or interest from an addiction is the inability to control the behavior despite the negative consequences it has in your life.

Some signs and symptoms that sexual thoughts or behaviors may be obsessive, excessive, or compulsive:⁵

• Difficulty controlling sexual impulses
• Repetitive sexual behaviors that continue despite negative consequences
• Relationship problems that occur as a result of compulsive sexual behaviors
• Hiding or lying about compulsive sexual behaviors
• Taking significant risks, such as having unprotected sex with multiple partners or spending large amounts of money on sex
• Feelings of loneliness, anxiety, depression, high stress, or overwhelm related to sex

How Does Alcohol Affect Sexual Behavior?

Little research has been done on the connection between alcohol use disorder and sex addiction. It is difficult to say with certainty whether one can cause the other, but the signs and symptoms of both can definitely contribute to the other addiction.

Alcohol consumption is known to increase high-risk sexual behaviors.² People with sex addiction may also use alcohol to lower inhibitions when engaging in sexual acts, which could increase the risk of developing co-occurring alcohol addiction.

Compulsive sex and alcohol addiction may frequently co-occur. In a study of 103 men seeking treatment for compulsive sexual behaviors, 41% had a co-occurring substance use disorder.³

According to the Semel Institute for Neuroscience and Human Behavior, alcohol use is a risk factor for sex addiction.⁵ Alcohol lowers inhibitions, disrupts decision-making processes, and is associated with increased risk-taking, all of which could contribute to compulsive sexual behaviors.⁴

There may be a connection between alcohol addiction and sex drive. The amount of alcohol consumed affects sexual behavior. Heavy drinking is associated with sexual risk-taking. The more you drink, the greater your risk of engaging in risky sexual behavior. Research has shown that blood alcohol concentrations (BACs) of .07 or higher increase the motivation to engage in risky sexual behaviors.⁶

Alcohol Myopia Theory

Researchers have referred to alcohol myopia theory as the most important theory for understanding the association between alcohol consumption and sexual risk-taking and sexual victimization.⁷

Alcohol myopia theory states that, due to alcohol’s pharmacologic effects on information processing, alcohol intoxication creates a cognitive impairment that makes it difficult for people to attend fully to situational cues. This means that when people are intoxicated who are less able to attend to distal cues such as STI or pregnancy risk and attend more to proximal cues like sexual arousal, which leads to more risky sexual behaviors.⁷

Treating Alcohol and Sex Addiction

If you are struggling with addiction to both sex and alcohol, you will need to treat symptoms of both disorders. If you have any other problematic repetitive or compulsive behaviors, always disclose this information with your treatment team because it is vital to your recovery. Because of the nature of addiction, people in recovery may replace drinking with other addictive or compulsive behaviors.

Counseling and Psychotherapy

Because sex addiction has still not been defined as a clinical disorder, little research has been done on the efficacy of treatment for sexual addiction and compulsive sexual behavior. Many people find relief through evidence-based therapies like acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT).³

These therapies may also help treat co-occurring symptoms of alcohol use disorder as well. CBT is one of the most commonly used therapeutic methods in alcohol addiction treatment.

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Medication

In some cases, medication may be helpful in treating symptoms of sex addiction. While no large-scale studies have been done, preliminary research shows that selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa) reduce compulsive sexual behaviors and other sex addiction symptoms.³

Studies also show that the opioid antagonist naltrexone helps to reduce compulsive sexual behaviors.³ Because naltrexone is also used to reduce the risk of relapse when treating alcohol use disorder, this may be an effective treatment option for people with both alcohol and sex addiction.⁹

Peer Support Groups and 12-Step Programs

Many people enter peer support groups and 12-step programs for support with sex addiction. The 12-step programs available for sex addiction are based on the 12 Steps of Alcoholics Anonymous (AA). Abstinence is the goal of 12-step programs. With sex addiction, people may choose to remain abstinent from specific sexual behaviors that are compulsive or problematic for them.⁹

Sexaholics Anonymous (SA) is a popular 12-step program that has support groups available worldwide. In the United States, other 12-step groups for sex addiction are:⁹

• Sexual Compulsives Anonymous
• Sexual Recovery Anonymous
• Sex Addicts Anonymous
• Sex and Love Addicts Anonymous

Because the 12-step process is the same for both sex and alcohol addiction, attending 12-step meetings for one addiction could help to treat the symptoms of both addictions. You may attend meetings for both alcohol and sex addiction, rather than just one or the other.¹⁰

Inpatient Rehab for Sex and Alcohol Addiction

While little to no extensive research has been done, inpatient rehab programs are available specifically for people struggling with severe sex addiction. Inpatient treatment may also be a good option for those with both sex and alcohol addiction.

If you attend inpatient rehab, you will receive individual therapy, group counseling, peer support groups, medications, medically assisted detox support, and other therapeutic treatments all in one place. You would reside in the facility 24/7 for a specific duration of time, usually ranging from 30-90 days, but sometimes longer depending on addiction severity and individual treatment needs.⁸

If you are struggling with co-occurring symptoms of sex and alcohol addiction, treatment and support are available. For more information on addiction treatment options, call 800-948-8417 Who Answers? to speak with a treatment specialist today.

Resources

1. National Institute on Alcohol Abuse and Alcoholism. (2022). Alcohol Facts and Statistics.
2. American Psychological Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. American Psychological Association Publishing.
3. Kraus, S., Voon. V., & Potenza, M. (2017, December 01). Should compulsive sexual behavior be considered an addiction? Addiction, 111(12), 2097-2106.
4. Korlakunta, A. & Pavankumar Reddy, C. 2019). High risk behavior in patients with alcohol dependence. Indian Journal of Psychiatry, 61(2), 125-30.
5. Semel Institute for Neuroscience and Human Behavior. (2022). Sex Addiction, Pathological Gambling, and Other Mental Health Disorders.
6. Wells, B., Kelly, B., Golub, S., Grov, C., & Parsons, J. (2018, February 23). Patterns of Alcohol Consumption and Sexual Behavior Among Young Adults in Nightclubs. American Journal of Drug and Alcohol Abuse, 36(1), 39-45.
7. Garcia, T., Litt, D., Davis, K., Norris, J., Kaysen, D., & Lewis, M. (2019, August 22). Growing Up, Hooking Up, and Drinking: A Review of Uncommitted Sexual Behavior and Its Association With Alcohol Use and Related Consequences Among Adolescents and Young Adults in the United States. Frontiers in Psychology.
8. Center for Disease Control and Prevention. (2019, March 29). Substance Use and Sexual Behaviors Among Youth.
9. National Institute on Alcohol Abuse and Alcoholism. (2021). Treatment for Alcohol Problems: Finding and Getting Help.
10. Efrati, Y. & Gola, M. (2018). Compulsive sexual behavior: A 12-step therapeutic approach. Journal of Behavioral Addictions, 7(2), 445-453.